<%@ include file="include.jsp" %>
<!-- start main page -->

<div id="content-wrap">
<div id="main"><br />
<h3>
We need just a few pieces of information...</h3>
<br />
<div style="text-align: right;">
<form:form action="confirmNewUser.html" modelAttribute="newUser">

User name: <form:input path="username"/><br/><form:errors path="username" cssClass="error" />
<br />
<br />
Password: <form:input path="password"/><br/><form:errors path="password" cssClass="error" />
<br />
<br />
E-mail Address: <form:input path="email"/><br/><form:errors path="email" cssClass="error" />
<br />
<br />
Age: <form:input path="age" maxlength="2" /><br/><form:errors path="age" cssClass="error" />
<br />
<br />
Gender:<SELECT name=gender> 
<OPTION value=true selected>male</OPTION> 
<OPTION value=false>female</OPTION> 
</select>
<br />
<br />
Zip Code: <form:input path="zip" maxlength="5" /><br/><form:errors path="zip" cssClass="error" />
<br />
<br />
<form:checkbox path="agreeToTerms"  value="true"/>By checking this box, I have read and agree to the <br />
Terms of Use and Privacy Policy of U-Rate-Drugs.com<br /><form:errors path="agreeToTerms" cssClass="error" />
<br />
<br />
<input type="submit" name="submit" value="Submit">
</form:form>




</div>

<p></p>
<br />
</div>

<div id="sidebar">
<div style="text-align: left;"></div>
<h3 style="text-align: left;"><img style="width: 225px; height: 129px;" alt="" src="images/bluepill.jpg" /><br /></h3><br /></div>
</div>









<!-- end main page -->
